Provider Demographics
NPI:1467691170
Name:FULTON, DONITA J (RN)
Entity Type:Individual
Prefix:
First Name:DONITA
Middle Name:J
Last Name:FULTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DONITA
Other - Middle Name:J
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1140 W 500 S
Mailing Address - Street 2:PO BOX 1908
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-2914
Mailing Address - Country:US
Mailing Address - Phone:435-789-6300
Mailing Address - Fax:435-789-6325
Practice Address - Street 1:1140 W 500 S
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-2914
Practice Address - Country:US
Practice Address - Phone:435-789-6300
Practice Address - Fax:435-789-6325
Is Sole Proprietor?:No
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX660982163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse